THE SAVING OF CHILD LIFE.
AT the close of a baptismal service formerly used by some part of the English Church parents were solemnly warned that for seven years it would be their duty to protect the helpless infant from all danger of fire, hound's tooth, and horse's hoof, and that he must not share the parental bed until old enough to make the emphatic remon- strance, " Fader, lig outer" (Father, lie further off !) when in peril of suffocation. If some such warning were addressed to parents at the present day, if "fire" were interpreted as all danger that the child might meet in his own home, " horse's hoof " as those which lay outside it, and " hound's tooth" as all preventable disease, he might have a better prospect of reaching an age when he could profitably "bear sermons."
We are all agreed as to the value of child life, and from a national as well as a humanitarian standpoint are determined to preserve it. All of us who are acquainted either with the theory or the practice of child-rearing are tolerably well agreed as to the conditions which strengthen delicate children, cure sick ones, and maintain and increase the health of the vigorous. The great question that remains to be decided is : On whom does the responsibility rest of preserving the life and health of the child population P " On the State " is the immediate response received from one quarter, regardless of the fact that the State may (and not infrequently does) materialize as a man clerk presenting leaflets to an illiterate woman, or as a Poor Law Guardian of rather forbidding exterior perfunctorily questioning boarded-out children twice a year, or a Sanitary Inspector with a district so large and duties so varied that a conscientious person would speedily be driven to his grave or a lunatic asylum. "Solely the parents' responsibility" is the unhesitating reply of others, boldly ignoring the inconvenient fact that the parents may be a half-witted woman and a street-corner man, or (more probably) a factory hand and a casual labourer, that they may be represented by a penniless, friendless girl, or, far worse, by her elder sister, who recalls with grim satisfaction that "the last didn't trouble her long, not after she left the House."
In practical life we find that the responsibility has to be divided, and to our sorrow we learn that divided responsibility is weakened responsibility, and that its ditties are hard to enforce. Our only hope of success lies in quickening the general moral sense and strengthening and directing moral purpose. Legal and moral responsibility for the wise up- bringing of every child rests first on the parents, then on the State which chooses, or is compelled, to replace them; heavy moral responsibility rests upon every individual who knows of an ill-cared-for child and does not do his utmost to improve the permanent conditions of his life. Heaven grant us patience with those who devote their time and other people's money to bestowing what they call "a ray of bright- ness" on him ! If a child has kind guardians and decent surroundings, he needs no other happiness ; if he has not, he is deprived of his plain rights as a human being.
It is impossible for our attempts at saving child-life to begin too early, and they commonly begin far too late to be of much practical use. Only too often no help or advice has been given to even the most ignorant mother until she has two children in their graves, one far on its way thither, and another deformed from malnutrition, and probably her own health ruined in addition. To begin even with the birth of the first child is not soon enough, especially in the poor and careless households where the greatest loss of life and undermining of health occur. The mother should be visited five or six months before the event, instructed in the care of her own
health and the improvement of her immediate surroundings, and persuaded to join a maternity club and save the money to meet the inevitable expenses. The child's little outfit forms a small part of these: the doctor or midwife must be paid, and if there is no mother or sister available a woman must be engaged to wait on the mother and do the housework for at least ten days; nourishing food and many other outlays are unavoidable.
Another point most necessary in the child's interest is that the mother should make up her mind from the first that she intends to nurse it. In case of hesitation a favourite doctor or a popular nurse can often turn the balance by refusing to attend the confinement unless they receive a solemn promise that the child shall be nursed for at least four months. I knew a clergyman's wife who made it her business to call on all parishioners—even the moderately well-to-do—and inquire the mothers' intentions in this respect. If they declined to nurse the child, or were uncertain, she pointed out to them the extreme difficulty of bringing up a child properly by hand, and the extreme wickedness of doing it badly, and her experience as the successful mother of a large family gave her opinion much weight. Among the very poor, one need never be afraid of saying the same things often and tediously; provided that all give the same advice, the number of counsellors cannot well be too great. To the educated mind brevity may be the soul of wit, but to the uneducated wordi- ness and repetition are the soul of certainty—at any rate its sole test.
In dealing with this matter it must be remembered that inability to nurse is rarely a fixed and unalterable condition. On inquiry innumerable mothers will tell you that they " could" nurse A and " couldn't " nurse B and " didn't " nurse C. That is to say, " couldn't" referred to a state of health which would probably have yielded to care and suitable nourishment and " didn't" to some desire to try an easier plan. When nursing is really impossible, or for some valid reason undesirable, careful and repeated instruction must be given as to the nature of the artificial food, its preparation, the hours when it should be given, and the quantity needed. When thoroughly understood, the teaching should be sum- marized on a neatly written card to be kept for reference. Teachers must be extremely careful to make their methods practicable. It is worse than useless to speak to women who have a home, a husband, and several children to work for as if they could devote themselves entirely to the baby. One may be fairly well satisfied if the child is fed solely on fresh milk served in an absolutely clean bottle and raised to blood heat by the addition of a little boiling water, and if the meals are given at regular intervals. The teacher must be careful to speak as if convinced that the mother wishes to do her utmost for the child, and as if it were quite possible to be a most respectable and intelligent woman and yet be in need of a little instruction as to the artificial feeding of infants.
The child should be kept under regular observation ; if this is not possible it should at least be visited and carefully examined and weighed at three months of age, and again at five or six months, as even in the case of a fairly healthy and well-nourished mother its food may need to be supplemented. Between the eighth and the tenth month several visits should be paid and detailed instruction given as to the change of diet which then becomes necessary. It is always difficult to make the uneducated recognize the desirability of steady, gradual change. Among the majority of my patients I found that the period of convalescence was practically unknown ; they lay in bed and expected to be waited on " hand and foot," then suddenly arose, put on boots that weighed seven pounds. and tried to go about their usual work.
The question of sleeping accommodation, so lightly settled by the advocates of orange boxes and empty drawers, is com- plicated by the fact that many, if not most, of the children born in the poorest homes are deficient in vitality: they do not generate enough heat to keep themselves warm, and the application of artificial heat in the shape of hot-water bottles or hot bricks cannot safely be recommended. A plan described to me by a missionary's wife as being common among all classes in the West Indies, and as having been adopted by herself, seems to me desirable. The infant is placed in a little hammock, which is slung across the bed a few inches above its level; it is within easy reach of the mother's arms, and can at any moment be drawn into their warmth and shelter. The clothing of young children needs simplification, especially as they must be dressed and undressed by hands which, however anxiously tender, cannot at once become skilful. Mothers are seldom aware of the importance of keeping a child's hands and feet warm.
With regard to the other members of the family, time bestowed on the father's instruction is rarely wasted, especially if devoted to general warnings and recommendations as to the ventilation of the house and the proper condition of yard and drainage. The grandmother should be specially warned as to the dangers of soothing syrups and teething powders, and assured that there would be entire lack of temptation to resort to them if reasonable care were taken with regard to diet and other matters affecting health. If there are any children in the house old enough to handle the baby they should be taught to appreciate its extreme fragility.
At the present moment it is the fashion to attribute the high death rate among infanta almost entirely to maternal ignorance and apathy. Work among the poor has given me the deepest sympathy with parents who lose their children from debility and disease. I know the devotion with which they have often been tended, and the limited responsibility which rests upon the individual parent even with regard to what are rightly termed " preventable " diseases. The nation can pre- vent phthisis or diphtheria or scarlatina as it has prevented small-pox and typhus and cholera, but neither the family, nor the street, nor even the whole parish has the power to do this. On the other hand, my heart becomes harder and harder against the parents whose children die from the result of domestic accidents. To the plea that the mother was busy, or forced to go out shopping, &c., one can only reply, There are tens of thousands of mothers in a similar position, but their children are unhurt. They put knives and matches and poison and boiling water out of reach ; they do not lay red-hot iron to cool within three feet of a crawling baby; they save money and buy a perambulator ; above all, they make some attempt to train their children to obedience—the only true safeguard of early childhood.
When we turn from ordinary family life the first class to be considered are the illegitimate children. In many cases they are feeble and immature, born to die ; but for the mother's moral regeneration, as well as for common humanity's sake, their lives should be prolonged to the last possible moment. In a much larger proportion they are vigorous and healthy children, and their death is a slow and cruel murder. When will people learn that the younger and more helpless the victim, the more uncompromising should be the condemnation of public opinion and the more rigorous the legal punishment? Most of the societies which concern themselves with the " rescue " of women care far too little for the fate of their children.
Passing to children on out-relief, we find that in England and Wales there are 130,000 of school age, of whom it is estimated that a very large percentage are ill-fed, ill-clothed, and in unhealthy surroundings. There are 15,000 under five years of age in Poor Law institutions, many of them living under conditions so unsatisfactory that nothing short of the authority of a Blue Book would make the account credible, and many others boarded out under a widely varying but generally insufficient amount of supervision. Truly, a wide field of endeavour is open to those who would save child life and raisf the national standard of health and efficiency !
M. LOANS.
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